- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $1,543.03 / $3,955.04
| Facility | | $1,518.41 | $1,543.03 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.25 / $114.75 / $208.62
| Professional | | $60.25 | $114.75 | $208.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.44 / $144.13 / $203.56
| Professional | | $67.44 | $144.13 | $203.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.21 / $124.81 / $283.02
| Professional | | $93.21 | $124.81 | $283.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $2,445.00 / $4,602.00
| Facility | | $1,388.00 | $2,445.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.44 / $196.95 / $330.19
| Professional | | $121.44 | $196.95 | $330.19 |